Recruitment of African American Women to a Walking Program: Eligibility, Ineligibility, and Attrition During Screening

Overcoming Pandemic-Related Challenges in Recruitment and Screening: Strategies and Representation of Older Women With Cardiovascular Disease for a Multidomain Lifestyle Trial to Prevent Cognitive Decline

BACKGROUND

Recruiting participants with cardiovascular disease into research during the COVID-19 pandemic was challenging, particularly those at risk of health disparities.

OBJECTIVE

During the pandemic, 12 cohorts of older women with cardiovascular disease were recruited from cardiology clinics into a lifestyle intervention trial to prevent cognitive decline. Objectives were to ( a ) describe the results of modified recruitment/screening strategies to overcome pandemic-related challenges and ( b ) evaluate differences in age, race, and ethnicity between patients recruited/randomized, recruited/not randomized (entered recruitment but not randomized because of being ineligible or not interested), and not recruited (clinic patients who met preliminary criteria but did not enter recruitment).

METHODS

This was a cross-sectional descriptive analysis. In-person study strategies proposed before the COVID-19 pandemic were modified before study onset (September 2020). Women 65 years or older with cardiovascular disease were recruited from cardiology clinics by clinicians, posted flyers, and letters mailed to patients randomly selected from electronic health record data extractions. Patients were classified as recruited/randomized, recruited/not randomized, and not recruited.

RESULTS

Of 5719 patients potentially eligible, 1689 patients entered recruitment via referral (49.1%), posted flyers (0.5%), or mailed letters (50.3%), and 253 patients were successfully recruited/randomized. Recruited/randomized participants were, on average, 72.4 years old (range, 65-90 years old), non-Hispanic White (54.2%), non-Hispanic Black (38.3%), Hispanic/Latinx (1.6%), and other/not reported (5.1%). The recruited/randomized group was significantly younger with fewer patients of Hispanic/Latinx ethnicity compared with those not recruited.

CONCLUSIONS

During the pandemic, all recruitment/screening goals were met using modified strategies. Differences in sociodemographic representation indicate a need for tailored strategies.

Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review

OBJECTIVE

To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management.

METHODS

Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles.

RESULTS

Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies.

CONCLUSION

This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.

Effects of the COVID‐19 pandemic on recruitment for the working women walking program

The global pandemic of coronavirus disease 2019 (COVID‐19) affected many aspects of randomized controlled trials, including recruiting and screening participants. The purpose of this paper is to (a) describe adjustments to recruitment and screening due to COVID‐19, (b) compare the proportional recruitment outcomes (not completed, ineligible, and eligible) at three screening stages (telephone, health assessment, and physical activity assessment) pre‐ and post‐COVID‐19 onset, and (c) compare baseline demographic characteristics pre‐ and post‐COVID‐19 onset in the Working Women Walking program. The design is a cross‐sectional descriptive analysis of recruitment and screening data from a 52‐week sequential multiple assignment randomized trial (SMART). Participants were women 18–70 years employed at a large urban medical center. Recruitment strategies shifted from in‐person and electronic to electronic only post‐COVID‐19 onset. In‐person eligibility screening for health and physical activity assessments continued post‐COVID‐19 onset with Centers for Disease Control and Prevention precautions. Of those who expressed interest in the study pre‐ and post‐COVID‐19 onset (n = 485 & n = 269 respectively), 40% (n = 194) met all eligibility criteria pre‐COVID‐19 onset, and 45.7% (n = 123) post‐COVID‐19 onset. Although there were differences in the proportions of participants who completed or were eligible for some of the screening stages, the final eligibility rates did not differ significantly pre‐COVID‐19 versus post‐COVID‐19 onset. Examination of differences in participant demographics between pre‐ and post‐COVID‐19 onset revealed a significant decrease in the percentage of Black women recruited into the study from pre‐ to post‐COVID‐19 onset. Studies recruiting participants into physical activity studies should explore the impact of historical factors on recruitment.

Recruiting African American parents of school-aged children in a physical activity study: Lessons learned

OBJECTIVES

To describe the recruitment strategies and lessons learned when enrolling African American parents/caregivers of school-aged children (ages 6-12 years) in an online survey of physical activity. With physical activity serving as a modifiable behavioral risk factor for several chronic diseases (obesity and cardiovascular diseases), little is understood regarding the influences on African Americans' physical activity participation to develop culturally appropriate physical activity interventions. Gaining a better understanding of physical activity influences is possible through research, yet recruiting and enrolling African Americans in health research is a challenge.

METHODS

Over a three-month period, a multidimensional approach (distribution of flyers, community partnerships, network sampling, African American researcher, effective communication, and data collection procedures) was used for study recruitment.

RESULTS

We exceeded our recruitment goal of 105 participants. A total of 127 African American parent/caregivers of school-aged children enrolled, which included both females/mothers (n = 87, 69%) and males/fathers (n = 40, 31%). Network sampling was the single most effective recruitment strategy for reaching this population. Lessons learned in this study includes considering participant burden and their comfort with technology, as well as gaining community trust.

DISCUSSION

Lessons learned in recruiting African American parents provides a guide for future research. Efforts are needed to further increase the representation of African American males in health research.

Caring in the recruitment of older African American adults with chronic health disease: An integrative review

OBJECTIVES

The aim of this integrative review is to accrue a comprehensive understanding of caring behavioral characteristics in the recruitment of older African-American adults into health-related research studies centered on chronic diseases.

METHODS

Combined methodologies, Whittemore & Knafl and Kable, Pich & Maslin-Prothero in accordance with preferred items for systematic reviews and meta-analysis, were used to guide the data collection and to report the findings. The data were analyzed based upon recruitment categorization and Kristen Swanson's middle-range theory of caring.

RESULTS

Ten out of 260 publications comprised the final sample. They were analyzed and then aggregated by chronic illnesses, recruitment activities, contact level, and Swanson's five caring behavioral concepts. Select cancers, diabetes, hypertension, and Alzheimer's disease were the chronic illness foci of eight publications. Cardiovascular disease and stroke were the focus of two publications. Only three studies utilized all five Swanson's caring concepts, and the frequently used concept throughout all 10 studies was enabling.

DISCUSSION

Recruitment approaches employed to accrue older African-American adults into chronic illness-related research studies necessitate proactive recruitment strategies that incorporate caring behaviors. Future researchers ought to develop multi-modality recruitment strategies to improve older African-American adults' representation.

A study protocol for MindMoves: A lifestyle physical activity and cognitive training intervention to prevent cognitive impairment in older women with cardiovascular disease

INTRODUCTION

Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affect women compared to men, and CVD increases risk of CI. Physical activity and cognitive training can improve cognition in older adults and may have additive or synergistic effects. However, no combined intervention has targeted women with CVD or utilized a sustainable lifestyle approach. The purpose of the trial is to evaluate efficacy of MindMoves, a 24-week multimodal physical activity and cognitive training intervention, on cognition and serum biomarkers in older women with CVD. Three serum biomarkers (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], and insulin-like growth factor 1 [IGF-1]) were selected as a priori hypothesized indicators of the effects of physical activity and/or cognitive training on cognition.

METHODS

The study design is a randomized controlled trial with a 2 × 2 factorial design, to determine independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity with goal-setting and group meetings) on change in cognition (primary outcome) and serum biomarkers (secondary outcomes). We will recruit 254 women aged ≥65 years with CVD and without CI from cardiology clinics. Women will be randomized to one of four conditions: (1) Mind, (2) Move, (3) MindMoves, or (4) usual care. Data will be obtained from participants at baseline, 24, 48, and 72 weeks.

DISCUSSION

This study will test efficacy of a lifestyle-focused intervention to prevent or delay cognitive impairment in older women with CVD and may identify relevant serum biomarkers that could be used as early indicators of intervention response.

Evidence to Improve Physical Activity among Medically Underserved Older adults: A Scoping Review

BACKGROUND AND OBJECTIVES

Participation in leisure physical activity (PA) and engagement in PA interventions among older adults is influenced by socioeconomic status (SES), race/ethnicity, and environment. However, studies of PA for medically underserved older adults have not yet been systematically evaluated. The objective of this study is to map the nature and extent of research conducted on PA participation, interventions, and components of effective leisure PA programs for medically underserved older adults.

RESEARCH DESIGN AND METHODS

The five-stage approach was used to conduct this scoping review. We searched PubMed, CINAHL, and Cochrane Library for peer-reviewed studies published between 2006 and 2016. Data extracted from selected studies included study population, study type, purpose of intent, evidence level, barriers to PA participation, and components of PA intervention.

RESULTS

Three hundred and ninety-two articles were identified, and 60 studies were included in the final data charting. Existing literature showed that most studies remained descriptive in nature, and few intervention studies have achieved a high level of evidence. Among 21 intervention studies, only 4 were explicitly conducted for older adults. Culturally adapted materials, race/ethnicity-specific barriers and facilitators, and form of intervention were important components for intervention programs.

DISCUSSION AND IMPLICATIONS

Findings indicate that more studies are needed to reduce health disparities related to PA participation for medically underserved older adults. Intervention components such as race/ethnicity-relevant barriers and facilitators and culturally sensitive materials are also needed for PA interventions targeting underserved older adults in order to provide evidence for best practices.

Study protocol for a sequential multiple assignment randomized trial (SMART) to improve physical activity in employed women

INTRODUCTION

Physical activity monitors, motivational text messages, personal calls, and group meetings, have proven to be efficacious physical activity interventions. However, individual participant response to these interventions varies drastically. A SMART design (sequential multiple assignment randomized trial) provides an effective way to test interventions that start with an initial treatment and then transition to an augmented treatment for non-responders. We describe a SMART to determine the most effective adaptive intervention to increase physical activity (steps, moderate-to-vigorous physical activity) and improve cardiovascular health among employed women who are not regularly physically active. The SMART uses combinations of four treatments: 1) enhanced physical activity monitor (Fitbit wearable activity monitor and mobile app with goal setting and physical activity prescription), 2) text messages, 3) personal calls, and 4) group meetings.

METHODS

Participants (N = 312) include women ages 18-70 employed at a large academic medical center. Women will be randomized to an initial intervention, either an enhanced physical activity monitor or enhanced physical activity monitor + text messaging. Non-responders to the initial intervention at 2 months will be randomized to either personal calls or groups meetings for the next 6 months. At 8 months, all participants will return to only an enhanced physical activity monitor until their final 12-month assessment.

DISCUSSION

Results of this study will add to the literature on improving physical activity in employed women. This study will identify effective interventions for women who respond to less intensive treatments, while maximizing benefits for those who need a more intensive approach.

Recruitment and Retention of Asian Americans in Web-Based Physical Activity Promotion Programs: A Discussion Paper

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.

Subjective Versus Objective Estimated Cardiovascular Disease Risk and Adherence to Physical Activity in African American Women

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death for African American (AA) women in the United States. Despite high prevalence of CVD risk factors, AA women perceive their CVD risk as low.

OBJECTIVE

Our objectives were to (1) identify relationships between subjective (self-reported perceived) CVD risk and objective CVD risk estimated by the American College of Cardiology/American Heart Association atherosclerotic CVD (ASCVD) risk estimator, (2) identify demographic and psychosocial factors associated with subjective perceived risk and discrepancy with objective estimated CVD risk, and (3) determine whether subjective perceived CVD risk was associated with physical activity (PA) adherence.

METHODS

This was a secondary data analysis of data collected from a 12-month lifestyle PA intervention conducted with 281 AA women. Subjective perceived CVD risk was measured by 1 question; objective estimated CVD risk was calculated using the ASCVD score. Women were categorized by congruence or discrepancy between subjective perceived and objective estimated CVD risk.

RESULTS

Subjective perceived CVD risk and objective ASCVD risk scores were both low. Approximately 20% subjectively perceived their risk as lower than objective ASCVD scores. Atherosclerotic CVD risk discrepancy groups differed by depressed mood symptoms. Participants reported many perceived barriers to PA. Perceived CVD risk was not related to PA adherence.

CONCLUSIONS

The significance of associated CVD risk factors may be underestimated by AA women, leading to discrepancy between subjective and objective risk estimates. Research is needed to clarify relationships among perceived risk, estimated risk using risk calculators such as ASCVD, and health behavior.

Recruitment Techniques and Strategies in a Community-Based Colorectal Cancer Screening Study of Men and Women of African Ancestry

BACKGROUND

Recruiting ethnically diverse Black participants to an innovative, community-based research study to reduce colorectal cancer screening disparities requires multipronged recruitment techniques.

OBJECTIVES

This article describes active, passive, and snowball recruitment techniques, and challenges and lessons learned in recruiting a diverse sample of Black participants.

METHODS

For each of the three recruitment techniques, data were collected on strategies, enrollment efficiency (participants enrolled/participants evaluated), and reasons for ineligibility.

RESULTS

Five hundred sixty individuals were evaluated, and 330 individuals were enrolled. Active recruitment yielded the highest number of enrolled participants, followed by passive and snowball. Snowball recruitment was the most efficient technique, with enrollment efficiency of 72.4%, followed by passive (58.1%) and active (55.7%) techniques. There were significant differences in gender, education, country of origin, health insurance, and having a regular physician by recruitment technique (p < .05).

DISCUSSION

Multipronged recruitment techniques should be employed to increase reach, diversity, and study participation rates among Blacks. Although each recruitment technique had a variable enrollment efficiency, the use of multipronged recruitment techniques can lead to successful enrollment of diverse Blacks into cancer prevention and control interventions.

A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial

Background

Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents.

Methods/design

Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments.

Discussion

This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations.

Trial registration

Clinical Trials NCT03683173, September 25, 2018.

Associations between Culturally Relevant Recruitment Strategies and Participant Interest, Enrollment and Generalizability in a Weight-loss Intervention for African American Families

OBJECTIVE

Culturally relevant recruitment strategies may be an important approach for recruiting ethnic minorities for interventions. Previous research has examined associations between recruitment strategies and enrollment of African Americans (AA), but has not explored more deeply the role of incorporating sociocultural values into recruitment strategies. Our current study explores whether sociocultural recruitment mediums were associated with demographics, interest and enrollment in a weight-loss intervention.

METHOD

Sociocultural mediums included community partnerships, culturally relevant ads, sociocultural events, or word-of-mouth. Non-sociocultural mediums included community/school events that did not specifically target AAs. Analyses examined whether demographics of enrolled families differed by recruitment strategy and if recruitment strategy predicted scheduling a baseline visit, enrolling in a run-in phase, and enrolling in the intervention program.

RESULTS

Families recruited from culturally relevant ads, sociocultural events, or word-of-mouth were 1.96 times more likely to schedule a baseline visit (OR=1.96, 95% CI=1.05, 3.68) than families recruited from non-sociocultural mediums. No differences were found for sociocultural mediums on enrolling in the run-in phase or the intervention. However, among enrolled families, those recruited from sociocultural mediums were less likely to be employed (X(2) [1, N=142] =5.53, P<.05) and more likely to have lower income (X(2) [1, N=142] =13.57, P<.05).

CONCLUSION

Sociocultural mediums were associated with scheduling a baseline visit, but not enrollment. They were, however, effective in recruiting a more generalizable sample among enrolled participants based on demographic characteristics. Integrating sociocultural values into recruitment methods may be a valuable strategy for increasing interest in participation among underrepresented AA families.

Retention of African American Women in a Lifestyle Physical Activity Program

The purpose of the article is to examine how well individual characteristics, neighborhood characteristics, and intervention participation predict study retention and staff level of effort needed for retention, using a cohort of African American women enrolled in a physical activity program. Secondary data analysis was conducted from a randomized clinical trial. Participants were aged 40 to 65 years without major signs/symptoms of cardiovascular disease. Assessments were conducted at community sites in/bordering African American communities. Study retention was 90%. Of those retained, 24% required moderate/high level of staff effort for retention. Retention was predicted by being older, having lower perceived neighborhood walkability, living in neighborhoods with greater disadvantage and crime, and having greater program participation. More staff effort was predicted by participants being younger, having more economic hardships, poorer health, or lower intervention participation. We may be able to identify people at baseline likely to require more staff effort to retain.

Recruitment lessons learned from a tailored web-based health intervention Project Y.E.A.H. (Young Adults Eating and Active for Health)

Purpose

– Recruiting college students for research studies can be challenging. The purpose of this paper is to describe the lessons learned in the various recruitment strategies used for enrolling college students in a theory-based, tailored, and web-delivered health intervention at 13 US universities.

Design/methodology/approach

– The community-based participatory research (CBPR) model was used to develop a staged-tailored, web-based, randomized control trial, focussing on eating behavior, physical activity, and stress management. Participant feedback during baseline assessments was used to evaluate recruitment strategies.

Findings

– Findings from this feedback suggest that traditional recruitment strategies, such as newspaper ads and flyers, may not be the best approach for recruiting college students; instead, web-based efforts proved to be a better recruitment strategy.

Research limitations/implications

– This project included results from 13 US universities and thus may not be generalizable: more research is needed to determine successful recruitment methods for 18-24 years old college students.

Originality/value

– This paper lessens the gap regarding successful recruitment strategies for 18-24 years old college students.

What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings

The purposes of this review are to (1) describe recruitment and retention strategies for physical activity interventions focusing on underserved populations and (2) identify successful strategies which show the most promise for "best practices" recommendations to guide future research. The method used was systematic review. Data on recruitment and retention strategies were abstracted and analyzed according to participant characteristics, types of strategies used, and effectiveness using an ecological framework. Thirty-eight studies were identified. Populations included African American (n = 25), Hispanic (n = 8), or Asian (n = 3) groups. Successful recruitment strategies consisted of partnering with respected community stakeholders and organizations, well-trained study staff ethnically, linguistically, and culturally matched to the population of interest, and use of multiple advertising channels. Successful retention strategies included efficient administrative tracking of participants, persistence, skillful teamwork, and demonstrating a positive, caring attitude towards participants. Promising recruitment and retention strategies correspond to all levels of ecological influence: individual, interpersonal, organizational, and societal.

Effectiveness, efficiency, duration, and costs of recruiting for an African American women's lifestyle physical activity program

In a 48-week lifestyle physical activity controlled trial in African American women, we analyzed recruitment effectiveness, efficiency, duration, and costs. Social networking was the most effective approach for inviting women to the trial. Of the 609 who responded to invitations, 514 completed telephone screening; of these, 409 (80%) were found eligible. The health assessment screening was completed by 337 women; of these, 297 (88%) were found eligible. The mean number of days from completion of the telephone and health assessment screenings to beginning the intervention was 23.01, and the mean cost was $74.57 per person. Results suggest that provision of health assessment screening by study staff as part of recruitment is effective for minimizing attrition and also might be cost-effective.

Self-silencing as a predictor of physical activity behavior

Self-silencing theory suggests that women ignore their own feelings and needs to attend to the desires of others. However, the impact of such self-silencing on physical activity behavior is unknown. This study examined the degree of self-silencing among a group of highly educated and relatively affluent African American women and the strength of self-silencing as a predictor of physical activity. The mean total self-silencing score for participants was 71.46. Overall, women reported spending approximately 193 min per week engaged in physical activity but only 36% met current recommendations for aerobic physical activity. Self-silencing did not predict physical activity behavior.

Racial/ethnic differences in midlife women's attitudes toward physical activity

INTRODUCTION

Women's racial/ethnic-specific attitudes toward physical activity have been pointed out as a plausible reason for their low participation rates in physical activity. However, very little is actually known about racial/ethnic commonalities and differences in midlife women's attitudes toward physical activity. The purpose of this study was to explore commonalities and differences in midlife women's attitudes toward physical activity among 4 major racial/ethnic groups in the United States (whites, Hispanics, African Americans, and Asians).

METHODS

This was a secondary analysis of the qualitative data from a larger study that explored midlife women's attitudes toward physical activity. Qualitative data from 4 racial/ethnic-specific online forums among 90 midlife women were used for this study. The data were analyzed using thematic analysis, and themes reflecting commonalties and differences in the women's attitudes toward physical activity across the racial/ethnic groups were extracted.

RESULTS

The themes reflecting the commonalities were: 1) physical activity is good for health, 2) not as active as I could be, 3) physical activity was not encouraged, 4) inherited diseases motivated participation in physical activity, and 5) lack of accessibility to physical activity. The themes reflecting the differences were: 1) physical activity as necessity or luxury, 2) organized versus natural physical activity, 3) individual versus family-oriented physical activity, and 4) beauty ideal or culturally accepted physical appearance.

DISCUSSION

Developing an intervention that could change the social influences and environmental factors and address the women's racial/ethnic-specific attitudes would be a priority in increasing physical activity of racial/ethnic minority midlife women.

Attitudes of women in midlife to web-based interventions for promoting physical activity

We explored the attitudes of women at midlife to web-based interventions for promoting physical activity. 145 women volunteered to participate in one of four online forums. The forums were for four major racial/ethnic groups. 90 volunteers were recruited for the online forums (29 Whites, 23 Hispanics, 21 African Americans, and 17 Asians). Two sets of topics on attitudes to physical activity and racial/ethnic contexts were used. Each topic had some introductory questions and related prompts, and these were posted on the online forum sites in a serial fashion during the six-month period. We used a thematic analysis. Four major themes emerged: (1) ‘a matter of the source of the information’; (2) ‘I can pace myself’; (3) ‘lack of interpersonal interactions’; and (4) ‘culture-specificity and low cost.’ The women in all ethnic groups thought that the source of the information was much more important than the medium of the information (e.g. web-based, booklet or face-to-face). They liked the self-controllability in web-based interventions. They preferred web-based interventions to other types of interventions because of easy accessibility, but they were concerned about lack of interpersonal interaction. None of the White or African American women indicated the need for culture-specificity in web-based interventions, but Hispanic and Asian women indicated that culture-specific interventions should be provided. Web-based interventions appear to have several advantages over conventional approaches to promoting physical activity.

Asian American midlife women's attitudes toward physical activity

OBJECTIVES

To explore Asian American midlife women's attitudes toward physical activity using a feminist perspective.

DESIGN

A qualitative online forum study.

SETTINGS

Internet communities/groups for midlife women and ethnic minorities.

PARTICIPANTS

A total of 17 Asian American women recruited through the Internet using a convenience sampling method.

METHODS

A 6-month qualitative online forum was conducted using 17 online forum topics. The data were analyzed using thematic analysis.

RESULTS

Three major themes related to Asian American midlife women's attitudes toward physical activity were extracted from the data: keeping traditions, not a priority, and not for Asian girls. Because Asian American midlife women were busy in keeping their cultural traditions, they rarely found time for physical activity. The women gave the highest priority to their children, and physical activity was the lowest priority in their busy lives. Also, the women were rarely encouraged to participate in physical activity during their childhoods, and they perceived that their weak and small bodies were not appropriate for physical activity.

CONCLUSIONS

Several implications for future development of physical activity promotion programs for this specific population have been suggested based on the findings.

Challenges and opportunities in pain management disparities research: implications for clinical practice, advocacy, and policy

Due to high profile initiatives at the national level, awareness of inadequate pain care affecting many groups in our society has never been greater. Nevertheless, increased awareness of pain disparities and the initiatives to address these disparities have yielded only modest progress, most notably in the form of growing appreciation that pain disparities likely result from multiple factors, including biological, psychological, environmental, health system, and cultural factors. Much less progress has been made in developing interventions that target these multiple determinants to reduce pain management disparities. In this paper we discuss key ethical and methodological challenges that undermine our capacity to investigate and develop meaningful interventions to improve pain outcomes among vulnerable populations. Key challenges in the areas of research engagement, recruitment, design, and measurement are discussed from both scientific and normative standpoints. Specific opportunities within emerging research paradigms to improve designs and measures are also discussed. Finally, we conclude with identifying potential synergies between the pain management disparities research agenda and the broader areas of clinical practice, advocacy, and policy that could help to move the field forward.

PERSPECTIVE

Researchers studying disparities in pain care face a number of ethical and methodological challenges that must be addressed to advance the field towards eliminating disparities. We discuss these ethical and methodological challenges and propose opportunities for paradigmatic revisions in areas of research engagement, design, measurement, advocacy, and policy.

Women's walking program for African American women: expectations and recommendations from participants as experts

Effective interventions that increase adherence to physical activity are important for African American women because generally they are less active and more obese compared to white American women. The purpose of the authors in this study was to elicit from women who began a 12-month physical activity program between 2002 and 2005: (1) their recollections of outcome expectations and barriers, (2) feedback on program components, and (3) suggestions for program change. In 2007, the authors conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three African American women aged 44-69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked<50% of expected walks) versus high (walked≥50% of expected walks) adherence and low (0-2) versus high (3-4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed, coded independently, and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components include a lifestyle physical activity prescription, pedometers for self-monitoring, ongoing group support, and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.

Attitudes toward physical activity of white midlife women

OBJECTIVE

To explore attitudes toward physical activity of White midlife women in the United States using a feminist perspective.

DESIGN

A cross-sectional qualitative study using a thematic analysis.

SETTING

Internet communities for midlife women.

PARTICIPANTS

Twenty-nine White midlife women in the United States recruited using a convenience sampling method.

METHODS

We used 17 topics on attitudes toward physical activity and ethnic-specific contexts to administer an online forum. We analyzed the data using thematic analysis.

RESULTS

We found three themes: thinking without action, gendered and sedentary culture, and motivating myself. The women knew and understood the necessity of physical activity for their physical and mental health but in most cases had not been able to take action to increase their physical activities. Although the culture that circumscribed the women's physical activity was sedentary in nature, the women tried to motivate themselves to increase their physical activities through several creative strategies.

CONCLUSION

The findings strongly suggest that although women were doing their best, American culture itself needs to be changed to help women increase physical activity in their daily lives.

Attempts to reach the oldest and frailest: recruitment, adherence, and retention of urban elderly persons to a falls reduction exercise program

PURPOSE OF THE STUDY

To assess the recruitment, adherence, and retention of urban elderly, predominantly African Americans to a falls reduction exercise program.

DESIGN AND METHODS

The randomized controlled trial was designed as an intervention development pilot study. The goal was to develop a culturally sensitive intervention for elderly persons who suffered a fall and visited an emergency department (ED). Participants were taught exercises during 4 on-site group classes and encouraged to continue exercising at home for 12 weeks and attend additional on-site monthly classes. The protocol included a specifically designed intervention for increasing retention through trained community interventionists drawn from the participants' neighborhoods.

RESULTS

The screening of 1,521 ED records after falling yielded the recruitment of 204 patients aged 65 years and older. Half were randomized into the falls prevention program. Of the 102 people in the intervention group, 92 completed the final 6-month assessment, 68 attended all on-site sessions, but only 1 reported exercising at home all 12 weeks. Those who lived alone were more likely (p = .03) and those with symptoms of depression were less likely (p = .05) to attend all on-site exercise classes. The final recruitment rate was estimated as 31.8%. The final retention rates were 90.2% and 87.3% for the intervention and control groups, respectively.

IMPLICATIONS

Recruitment of frail elderly African American patients is resource intensive. Adherence to the on-site exercise classes was better than to the home-based component of the program. These findings have implications for the design of future community-based exercise programs and trials.

"Physical activity as a luxury": African American women's attitudes toward physical activity

The purpose of this study was to explore African American midlife women's attitudes toward physical activity. Using a feminist perspective, a 6-month online forum was conducted with 21 African American midlife women recruited on the Internet. The data were analyzed using thematic analysis. Four themes emerged: (a) culturally acceptable body, (b) missed opportunity to learn, (c) physical activity as a luxury, and (d) want to do by myself. The women had positive body images regardless of their actual weight. The women considered physical activity "a luxury" in their busy lives and thought that they had already missed opportunities to learn. The women wanted to participate in physical activities alone because of their bad childhood experiences and hesitance to go out in public with sweaty, messy hair. The findings suggested that unique programs that promote physical activity should be developed that consider the women's ethnic-specific attitudes.

"A waste of time": Hispanic women's attitudes toward physical activity

Despite a lack of studies on Hispanic midlife women's physical activity, the existing studies have indicated that Hispanics' ethnic-specific attitudes toward physical activity contributed to their lack of physical activity. However, little is still clearly known about Hispanic midlife women's attitudes toward physical activity. The purpose of this study was to explore Hispanic midlife women's attitudes toward physical activity using a feminist perspective. The study was a 6-month qualitative online forum among 23 Hispanic women who were recruited through Internet communities/groups. The data were collected using 17 online forum topics on attitudes toward physical activity and ethnic-specific contexts. The data were analyzed using thematic analysis. Three major themes emerged from the data analysis process: (a) "family first, no time for myself," (b) "little exercise, but naturally healthy," and (c) "dad died of a heart attack." Although some of the women perceived the importance of physical activity due to their family history of chronic diseases, the study participants thought that physical activity would be a waste of time in their busy daily schedules. These findings provided directions for future health care practice and research to increase physical activity among Hispanic midlife women.

Strategies for Recruitment of Healthy Premenopausal Women into the African American Nutrition for Life (A NULIFE) Study

BACKGROUND

Although African American women have an overall lower incidence of breast cancer, African American women <40 years of age are more likely than Caucasian women of all ages and postmenopausal African American women to be diagnosed with breast cancer and exhibit tumor characteristics associated with poorer survival. To begin to address this disparity, studies must be conducted to examine breast cancer preventive factors in this subpopulation of women. However, the strategies needed to recruit younger African American women have not been well defined.

METHODS

In this study, we assessed methods used for recruiting and retaining healthy premenopausal African American women into the African American Nutrition for Life (A NULIFE) Study. The number of women contacted, enrolled, and retained by each recruitment strategy and the efficiency of individual strategies were calculated.

RESULTS

Overall, recruitment through social networking was most effective in contacting large numbers of healthy premenopausal African American women. The worksite recruitment method was the most efficient recruitment strategy employed, with a ratio of 40%. The study participants (n = 164) were more likely to be >or=35 years of age and have completed some college. Additionally, the interpersonal relationships recruitment approach proved most efficient (33%) in retaining participants who completed the yearlong study.

CONCLUSIONS

The findings from this study add to the evolving research literature on minority recruitment strategies for research studies but specifically address effective recruitment of healthy young premenopausal African American women. The results demonstrate the need to use multiple recruitment strategies when recruiting this subgroup of African American women.

Community-based strategies for recruiting older, African Americans into a behavioral intervention study

PURPOSE

To describe community-based strategies that were effective in recruiting older African Americans into a behavioral intervention study designed to increase eye examination behavior.

METHODS

Sites were identified that targeted older African-Americans, including senior centers, senior housing, and church groups. We conducted presentations at these sites, networked with community organizations, placed ads on the radio and in newspapers, and attended health fairs. Potential participants also called us in response to flyers and through word of mouth.

RESULTS

We conducted 147 activities at 118 sites. A total of 688 potential participants were screened, with 330 (48%) enrolling, 33% ineligible, and 19% not interested. Highest enrollment rates were for word of mouth (69%), flyers (67%), and senior centers (66%). Barriers to participation included hesitancy of seniors to leave their apartments to attend presentations and competing health issues taking precedence over eye concerns.

CONCLUSIONS

A multifaceted recruitment approach incorporating both direct and indirect activities at a variety of sites should be used to recruit older African Americans into a behavioral intervention study. Establishing relationships in the community, both prior to initiating recruitment activities and as an ongoing process, was important to the study's success.

Neighborhood characteristics, adherence to walking, and depressive symptoms in midlife African American women

BACKGROUND

African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women.

METHODS

Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included.

RESULTS

Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks.

CONCLUSIONS

Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.

Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons

Background

The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health.

Methods

A longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abdominal muscle strength, and low back and hamstring flexibility. Potential determinants of change in physical health were demographic variables, psychological variables (self-esteem, mastery, and kinesiophobia), and self-perceived health.

Results

The initial response was 73% and 252 persons had complete data collection at baseline. In total, 36 subjects were lost during follow-up. Participants were predominantly low educated, long-term unemployed, and in poor health. Participation in the programme was not influenced by demographic and psychological factors or by self-reported health. Drop-outs were younger and had a lower body mass index at baseline than subjects who completed the programme. At post-test, participants' cardiorespiratory fitness, abdominal muscle strength, and flexibility had increased by 6.8%–51.0%, whereas diastolic and systolic blood pressures had decreased by 2.2%–2.5%. The effect sizes ranges from 0.17–0.68.

Conclusion

Participants with the poorest physical health benefited most from the programme and gender differences in improvement were observed. Physical health of unemployed persons with health complaints improved after participation in this health promotion programme, but not sufficiently, considering their poor physical health at baseline.

Examining the challenges of recruiting women into a cardiac rehabilitation clinical trial

PURPOSE

To examine the challenges of recruiting women for a 5-year cardiac rehabilitation randomized clinical trial; the aims of the study were to describe the range of recruitment sources, examine the myriad of factors contributing to ineligibility and nonparticipation of women during protocol screening, and discuss the challenges of enrolling women in the trial.

METHODS

The Women's-Only Phase II Cardiac Rehabilitation program used an experimental design with 2 treatment groups. Eligible participants included women who were (1) diagnosed with a myocardial infarction or stable angina or had undergone coronary revascularization within the last 12 months; (2) able to read, write, and speak English; and (3) older than 21 years. Responses to multiple recruitment strategies including automatic hospital referrals, physician office referrals, mass mailings, media advertisements, and community outreach are described. Reasons for ineligibility and nonparticipation in the trial are explored.

RESULTS

Automatic hospital order was the largest source of referral (n = 1,367, 81%) accounting for the highest enrollment rate of women (n = 184, 73%). The barriers to enrollment into the cardiac rehabilitation clinical trial included patient-oriented, provider-oriented, and programmatic factors. Of the referral sources, 52% were screened ineligible for provider-oriented reasons, 31% were ineligible due to patient-oriented factors, and 17.4% were linked to the study protocol. Study nonparticipation of those eligible (73.8%) was largely associated with patient-oriented factors (65.2%), with far less due to provider-related factors (4%) or study-related factors (3.4%).

CONCLUSION

Standing hospital orders facilitated enrollment to the cardiac rehabilitation clinical trial, yet women failed to participate predominantly due to significant patient-oriented biopsychosocial barriers.

Neighborhood environment and adherence to a walking intervention in African American women

This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban, midlife African American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women's neighborhoods included walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. The presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African American women who want to be more active.

Outcomes of a Home-Based Walking Program for African-American Women

Purpose.

As compared with minimal treatment (MT), to determine the effectiveness of a home-based walking intervention enhanced by behavioral strategies targeted and tailored to African-American women (enhanced treatment [ET]) on adherence, physical activity, fitness, and body composition at 24 and 48 weeks.

Design.

Using a quasi-experimental design, treatments were randomly assigned to one of two community health centers.

Setting.

The centers were in predominately African-American communities.

Participants.

Sedentary women (156 ET, 125 MT) 40 to 65 years were recruited within a 3-mile radius of each center.

Intervention.

Both treatments had the same orientation. The ET group had four targeted workshops followed by weekly tailored telephone calls over 24 weeks.

Methods.

Generalized linear mixed models were used to test effects of treatments on adherence, physical activity, aerobic fitness, and body composition.

Results.

Adherence was significantly higher in the ET than the MT group and was related to the number of workshops attended (r = .58) and tailored calls (r = .25) received. On-treatment analysis showed significant postintervention improvement in waist circumference and fitness in the ET group; however, these improvements were not statistically different between the two groups. Intent to treat analysis showed a significant increase in fitness, decrease in waist circumference, and no change in body mass index in both treatments.

Conclusion.

Findings suggest the potential impact of workshop group support on adherence in African-American women.

Collecting data by telephone from low-income African Americans

The purposes of this report are to (a) describe challenges associated with collecting data by telephone from 368 urban-dwelling African Americans and (b) describe characteristics of easy-to-reach participants. Data collected through four telephone interviews were used for these analyses. Over 1 year, 55 (15.0%) participants had at least one telephone number change; 75 (20.4%) had their telephone disconnected. The mean (+/-SD) number of attempted telephone calls per participant was 9.5 (+/-4.0). Those who were easy to reach, requiring eight or fewer call attempts over 1 year (n = 170; 46%), were older (t = 3.0, p = .003), female (chi(2) = 4.6, p = .03), and currently not working (chi(2) = 7.9, p = .005).

Recruitment strategies and costs for a community-based physical activity program

A community-based participatory research project using social marketing strategies was implemented to promote physical activity among women aged 35 to 54 who were insufficiently active or completely inactive. A variety of media were used to disseminate messages about how to enroll in Step Up. Step Out! This article describes the effectiveness and cost of the recruitment strategies and lessons learned in recruiting the women. Of the total inquiries (n = 691), 430 women were eligible and enrolled in the program. Based on data from questionnaires, the most effective method of recruiting women into Step Up. Step Out! was word of mouth (36%). Newspaper ads accounted for 29% of the women's responses. The least effective method was billboards. Mass media was not as effective in recruiting women for the program as interpersonal efforts such as word of mouth. Interpersonal efforts are a valuable and possibly underrated recruitment and promotion tool.